Background:Opioid agonist therapy (OAT) is the gold standard of treatment for opioid dependence and a cornerstone of Swiss drug policy. The Swiss Association for the Medical Management in Substance Users (SAMMSU) cohort was established to monitor health trends and improve care for OAT patients across Switzerland. Methods:Baseline and follow-up data collected from eight centres between 2014 and 2024 were analysed descriptively, including demographic and psychosocial characteristics, substance use history, prescribed OAT, co-medications, and somatic and psychiatric comorbidities. Results:During the study, the SAMMSU cohort included 1 502 participants. Median individual age at registration was 44.3 years, rising to a cohort median of 50.9 years by the end of 2024; 75.7 % of participants were male. Lifetime heroin use was reported by 97.2 %, with 73.2 % having a history of intravenous drug use. Ongoing illicit and intravenous drug use declined over time, while prescribed OAT shifted from methadone to long-acting morphine and diacetylmorphine. The most prevalent lifetime somatic comorbidities were hepatitis C (56.5 %), (pre)hypertension (18.6 %), musculoskeletal disorders (13.8 %), and needle abscesses (13.7 %). Psychiatric disorders - primarily affective (34.8 %), personality (23.2 %), and anxiety disorders (18.0 %) - contributed to multimorbidity and a high prevalence of polypharmacy (49.2 %). There were 120 deaths, mainly from malignancy, overdose, and liver failure, with a median age at death of 51.6 years. Conclusion:SAMMSU cohort trends corroborate the effectiveness of OAT in reducing illicit drug use and underscore the need for OAT services to evolve from an addiction-focused model to comprehensive chronic care for an ageing and highly vulnerable population.

HR is a member of advisory boards for Gilead, AbbVie, Abbott, Merck, Janssen, Roche and VBI Vaccines. All proceeds were donated to Center for Disease Analysis Foundation. His organization has received research funding from Gilead, Assembly Biosciences, AbbVie, Boehringer Ingelheim, Intercept, Merck, Novartis, Pfizer and Roche. SB was an employee of the CDA Foundation. Otherwise, she has nothing else to declare. AB has received research funding from Gilead and Abbvie. The employer of PB has received project, research and travel grants from Abbvie and Gilead. BMüllhaupt has received speaking and/or consulting fees from Merck/MSD, AbbVie, Intercept, Astra, Bayer, BMS and Gilead Sciences and research support from Gilead Sciences. FN has served as a speaker, a consultant and an advisory board member for Gilead, AbbVie, Albireo, Genfit and Roche Diagnostics. DS has received research grants, consulting fees and/or speaker fees from AbbVie, Gilead and MSD. AS, CS and BMaeschli have no conflict of interests to declare. Data sharing is not applicable to this article as no new data were created or analyzed in this study.

ContexteDepuis le début de la guerre, le 24 février 2022, jusqu'au début du mois de juillet de cette année, plus de 58 000 personnes ont fui l'Ukraine pour se réfugier en Suisse.Outre l'aide humanitaire, la prise en charge médicale des personnes en quête de protection est également une priorité.Avec le statut de protection S, les ressortissants ukrainiens enregistrés en Suisse bénéficient également d'une assurance maladie.En raison du manque de ressources, les soins médicaux, en principe gratuits, sont limités en Ukraine [1].Même avant le début de la guerre, le pays présentait, en comparaison européenne, outre un nombre de cas de tuberculoses multirésistantes supérieur à la moyenne, une prévalence élevée des hépatites B et C ainsi que d'infections par le VIH.Les sociétés suisses d'infectiologie (SSI) et d'hépatologie (SASL)

Diese Empfehlungen wurden in Zusammenarbeit verschiedener Fachgesellschaften und Patientenorganisationen erarbeitet und dienen dazu, ein Nachsorgeprogramm fur erfolgreich behandelte Patientinnen und Patienten zu etablieren.

Ces recommandations ont ete elaborees par diverses societes professionnelles et organisations de patients pour assurer un programme de suivi pour les patients traites avec succes.

Die HIV-Diagnostik hat in den letzten zwei Jahren verschiedene Neuerungen erfahren. Was muss man 2021 über verkürzte Testintervalle, Selbsttests und die HIV-PCR wissen? Welche Bedeutung haben sie für die praktische Arbeit?

Le diagnostic du VIH a connu différentes nouveautés au cours des deux dernières années. Que faut-il savoir en 2021 sur les délais de test raccourcis, les autotests et la PCR VIH? Quelles sont leurs implications pour la pratique?

BACKGROUND:Switzerland has made strides towards hepatitis C virus elimination, but as of 2019, elimination was not guaranteed. However, political interest in viral hepatitis has been increasing. We sought to develop a better understanding of Switzerland's progress towards HCV elimination and the profile of remaining HCV-RNA-positive patients.METHODS:A previously described Markov model was updated with recent diagnosis and treatment data and run to generate new forecasts for HCV disease burden. Two scenarios were developed to evaluate HCV morbidity and mortality under the status quo and a scenario that achieves the Swiss Hepatitis Strategy Elimination targets. Next, an analysis was conducted to identify population segments bearing a high burden of disease, where future elimination efforts could be directed.RESULTS:At the beginning of 2020, an estimated 32 100 viremic infections remained in Switzerland (0.37% viremic prevalence). Adult (≥18 years of age) permanent residents born abroad represented the largest subpopulation, accounting for 56% of HCV infections. Thirteen countries accounted for ≥60% of viremic infections amongst permanent residents born abroad, with most people currently residing in Zurich, Vaud, Geneva, Bern, Aargau and Ticino. Amongst Swiss-born HCV-RNA-positive persons, two-thirds had a history of IDU, corresponding to 33% of total infections.CONCLUSIONS:In Switzerland, extra efforts for diagnosis and linkage to care are warranted in foreign-born populations and people with a history of drug use. Population-level measures (eg increasing the number of providers, increase screening) can identify patients who may have otherwise fallen through the gaps or avoided care because of stigma.

BACKGROUND Hepatitis C virus (HCV) infections in Switzerland are mainly related to intravenous drug use. Since 2017, all patients with chronic hepatitis C can be treated with direct-acting antivirals (DAAs) irrespective of fibrosis stage. In March 2019, the Federal Office of Public Health (FOPH) published guidelines for HCV management in people who use drugs. To achieve HCV elimination by 2030, 80% treatment uptake is necessary. AIM To evaluate the benefit of interferon-based and interferon-free HCV treatment in patients on opioid agonist therapy (OAT) and monitor HCV elimination, a 2-year study commissioned by the FOPH and conducted within the Swiss Association for the Medical Management in Substance Users (SAMMSU) cohort was performed. METHODS Since 2014, the SAMMSU cohort has recruited OAT patients from eight different centres throughout Switzerland. In addition to yearly follow up, cross-sectional data were collected at the time-points 1 May 2017, 1 May 2018 and 1 May 2019. HCV treatment uptake, adherence and success, as well as reinfection rates, the effect of early versus late treatment and the efficacy of the “treatment-as-prevention” approach were analysed. RESULTS Between 1 May 2017 and 1 May 2019, the number of patients enrolled into the SAMMSU cohort increased from 623 to 900: 78% were male, the median age was 45 years, 81% had ever used intravenous drugs, 13% were human immunodeficiency virus (HIV) positive and 66% were HCV antibody positive. HCV treatment up to 2012 was exclusively interferon based (maximum 21 patients/year) and since 2016 exclusively interferon free (102 patients in 2017). Treatment success increased from 57% (112/198; interferon based) to 97% (261/268; interferon free) irrespective of cirrhosis or prior non-response to interferon. Simultaneously, treatments became shorter and better tolerated in the interferon-free era, resulting in fewer preterm stops (17% vs 1%) and adherence problems (9% vs 2%). Between 2015 and 2018, the proportion of patients with no/mild fibrosis (F0/F1) at first HCV treatment increased from 0% to 61%. Earlier treatment reduced the duration of infectiousness. Between 1 May 2017 and 1 May 2019, the proportion of chronic hepatitis C patients ever treated increased from 62% (198/321) to 80% (391/490). In parallel, the HCV-RNA prevalence among HCV antibody-positive patients declined from 36% (139/385) to 19% (113/593). The reinfection rate after successful treatment was 2.7/100 person-years. The number of HCV first diagnoses per year decreased from >20 up to 2015 to <10 in 2017 and 2018. CONCLUSION With nearly 100% DAA treatment success and a low reinfection rate, treatment uptake directly translates into a reduction of HCV-RNA prevalence. Eighty percent treatment uptake is feasible in OAT patients, and adherence and treatment success are not worse than in other populations. Duration of infectiousness and thus HCV transmission can be reduced by early detection and treatment of chronic hepatitis C.

Für Hepatitis Schweiz: Philip Bruggmanna, Andreas Cernyb, David Fehra, Montserrat Fragac, Christophe Boesigerd, Olivia Keisere, Daniel Lavanchyf, Bettina Maeschlig, Francesco Negroh, Andri Rauchi, Claude Scheideggerj, Nasser Semmok a Arud Zentrum für Suchtmedizin, Zürich; b Epatocentro, Lugano; c Gastroenterologie und Hepatologie, Universitätsspital Lausanne; d Schweizerische Hepatitis C Vereinigung SHCV, Zürich; e Institute of Global Health, Universität Genf; f Consultant, Denges; g Geschäftsführung Hepatitis Schweiz, Zürich; h Gastroenterologie, Hepatologie und Klinische Pathologie, Universitätsspital Genf; i Universitätsklinik für Infektiologie, Inselspital, Universität Bern; j Privatpraxis, Basel; k UVCM, Hepatologie, Inselspital Bern

La Strategie suisse contre l’hepatite a – tout comme l’Organisation mondiale de la Sante (OMS) – pour objectif d’eliminer l’hepatite B et C d’ici 2030. Cela signifie que les taux de nouvelles infections et des sequelles doivent etre ramenes a proche de zero. Tous les instruments d’elimination, c’est-a-dire les mesures preventives, les therapies et les vaccinations, sont disponibles. Il s’agit maintenant de combler les lacunes en matiere d’education, de depistage et d’acces a la therapie a bas seuil.

Objective: Hepatitis C virus (HCV) infection is a major cause of liver disease. Since symptoms of chronic liver disease usually appear only late in the course of the disease, infected individuals may remain undiagnosed until advanced disease has developed. We aimed to investigate which screening strategies would be most effective to detect individuals unaware of their infection. Methods: We developed a mathematical model for HCV disease progression and compared the current practice of HCV testing in Switzerland with the following screening strategies: intensive screening of active injection drug users (IDU), screening of former IDU, screening of individuals originating from countries with high HCV prevalence, screening of individuals born 1951-1985 (birth-cohort) and universal screening. All screening interventions were considered in addition to a baseline scenario that reflected the current practice of HCV testing. Results: Within the first 4 years (2018-2021), every year, on average 650 cases were diagnosed in the baseline scenario, 660 with intensified IDU screening, 760 with former IDU screening, 830 with origin-based screening, 1420 with birth-cohort screening and 1940 with universal screening. No difference in liver-related mortality and incidence of end-stage liver disease between the screening scenarios was observed. Conclusion: Our results suggest that only large-scale screening of the general population could substantially accelerate the rate of HCV diagnosis and treatment in Switzerland and other countries with similar epidemics. However, this implies screening of a large population with low prevalence, and may trigger considerable numbers of false-positive and borderline test results.

«Guideline Digests» der Schweizerischen Gesellschaft fur Infektiologie (SSI) mit dem Ziel einer Optimierung des Antibiotikaverbrauchs.

«Guideline Digests» de la Societe Suisse d’Infectiologie (SSI) pour l’objectif d’optimiser l’utilisation des antibiotiques.

Seit 2002 nahm die Zahl der gemeldeten Syphilisdiagnosen in der Schweiz kontinuierlich zu. 2013 sind beim Bundesamt fur Gesundheit 1069 Meldungen eingegangen, von denen jedoch wegen fehlender Angaben nur die Halfte als Syphilisfalle klassifiziert wurden. 2011 wurde durch das BAG eine wichtige Neuerung eingefuhrt: Auf der arztlichen Erganzungsmeldung kann seither eine Re-Infektion ausdrucklich als solche ge­kennzeichnet werden.

Seit 2002 nahm die Zahl der gemeldeten Syphilisdiagnosen in der Schweiz kontinuierlich zu. 2013 sind beim Bundesamt für Gesundheit 1069 Meldungen eingegangen, von denen jedoch wegen fehlender Angaben nur die Hälfte als Syphilisfälle klassifiziert wurden. 2011 wurde durch das BAG eine wichtige Neuerung eingeführt: Auf der ärztlichen Ergänzungsmeldung kann seither eine Re-Infektion ausdrücklich als solche ge­kennzeichnet werden.